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Cwt i • S-�F- O3,1 MANDATORY CONTACTS C) San Joaquin County r� Local Health District: (Contact Name Time Date San Joaquin County Board of Supervisors: Contact Name Time Date H. HEALTH AND SAFETY CODE S 25180.7. (b) Any designated government employee who obtains information in the co -se of his official duties revealing the illegal discharge or threatened illegal discharge or threatened illegal discharge of a hazardous waste within the geographical area of his jurisdiction and who knows that such discharge or threatened discharge is likely to cause substantial injury to the public health or safety must, within seventy-two hours, disclose such information to the local Board of Supervisors and to the local health officer. Ho discipsure of information is required under this subdivision when otherwise prohibited by law, or when law enforcement personnel have determined that such disclosure would adversely affect an ongoing criminal investigation, or when the information is already general public knowledge within the. locality affected by the discharge or threatened discharge. (c) Any designated government employee who knowingly and intentionally fails to disclose information required to be disclosed under subdivision (b) shall, upon conviction. be punished by imprisonment in the county jail for not more than one year or by imprisonment in state prison for not more than three years. The court may also impose upon the person a fine of not less than five thousand dollars ($5.000) or more than twenty-five thousand dollars ($25.000). The felony conviction for violation of this section shall require forfeiture of government employment within thirty days of conviction. SiGNATURE DISCLOSURE i make this report on behalf of all the designated employees of the County, of San Joaquin, and the San Joaquin County Local Health District. and Agency Name Signature: Typed Name: Title: Date: i - 56)'h� Eli 22 03 (Rev. 11/87) /M U G� ti— Time: �/•y